Bruising on Limbs: Causes and When to Seek Help

Bruising on the limbs?

Dear Dr.
Chen,
I have been taking medication for hypertension for a long time, but about two months ago, I started noticing bruises the size of a ten-dollar coin appearing on my limbs.
They are not painful and disappear in about one to two weeks.
However, after some time (approximately a month after the last occurrence), the bruises reappear (usually about 2 to 5 each time).
I have previously consulted my hypertension specialist, who conducted blood tests that came back normal.
However, the frequent appearance of these bruises makes me feel uneasy, so I would like to ask you:
1.
Is this condition referred to as purpura?
2.
Which specialty should I consult for this issue?
3.
Could this be related to my long-term use of hypertension medication?
I have a history of allergies to several medications, which have been noted by my physician: Augmentin, Amoxicillin, Ibuprofen, Voren, Thiamphenicol, Ponstan, Doxycycline, etc.
(Some of the handwriting was unclear, so I have made educated guesses on the spelling).
I would greatly appreciate your guidance on these concerns.
Thank you very much.

Gui Xiang, 50~59 year old female. Ask Date: 2013/08/18

Dr. Chen Qingbin reply Internal Medicine

Hello, Gui Xiang.
Your bruising could have various causes, so it's best to consult a family physician for long-term follow-up and examination.
Thank you for your message.

Reply Date: 2013/08/18

More Info

Hello, thank you for your detailed inquiry regarding the bruising on your limbs. Based on your description, it seems you are experiencing recurrent bruising, which can indeed be concerning. Let’s address your questions one by one.

1. Is this condition known as purpura?
The term "purpura" refers to purple spots or patches that occur due to bleeding underneath the skin. These can vary in size and may appear similar to the bruises you are describing. Purpura can be caused by a variety of factors, including blood vessel fragility, clotting disorders, or certain medications. Given that your bruises are not painful and resolve within a couple of weeks, they may fall under this category, but it’s essential to consider other potential causes as well.

2. Which medical specialty should you consult?
Given your symptoms and the fact that you have a history of hypertension and medication use, it would be prudent to consult a hematologist. A hematologist specializes in blood disorders and can conduct more specific tests to determine if there is an underlying issue with your blood cells or clotting mechanisms. Additionally, a visit to your primary care physician or a general internist could also be beneficial, as they can provide a comprehensive evaluation and refer you to a specialist if necessary.

3. Could this be related to your long-term use of antihypertensive medication?
Certain antihypertensive medications can have side effects that may contribute to bruising. For instance, medications like anticoagulants or antiplatelet drugs can increase the risk of bleeding and bruising. However, many common antihypertensive medications do not typically cause bruising as a side effect. It’s crucial to review your medication list with your healthcare provider to determine if any of your medications might be contributing to your symptoms.

Given your history of allergies to multiple medications, it’s also important to ensure that you are not experiencing an allergic reaction or sensitivity to any of your current medications. Allergic reactions can sometimes manifest in unusual ways, including skin changes.

Additional Considerations:
- Blood Tests: Since you mentioned that previous blood tests were normal, it might be worth discussing with your doctor the possibility of more specific tests, such as platelet counts, clotting factor levels, or even a bone marrow biopsy if indicated.

- Lifestyle Factors: Consider any lifestyle factors that may contribute to bruising, such as physical activity levels, dietary habits, or any recent changes in your routine.

- Monitoring Symptoms: Keep a detailed log of when the bruising occurs, any associated symptoms, and any changes in your medication or lifestyle. This information can be invaluable for your healthcare provider in diagnosing the issue.

In summary, while the bruising you are experiencing may be benign, it is essential to investigate further to rule out any serious underlying conditions. Consulting with a hematologist or your primary care physician would be the best course of action. They can provide you with a thorough evaluation and guide you on the next steps. Thank you for reaching out, and I hope you find the answers you need soon.

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